Percentage of long-term care home residents whose mood from symptoms of depression worsened

Percentage of long-term care home residents who suffered increased symptoms of depression

Percentage

The indicator is calculated using four rolling quarters of data by summing the number of residents that meet the inclusion criteria for the target quarter and each of the previous three fiscal quarters. This is done for both the numerator and denominator. The unadjusted value is the quotient of the summed numerator divided by the summed denominator, multiplied by 100 to get the percentage.

Number of long-term care home residents in the denominator with a higher Depression Rating Scale (DRS) score on their Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 target assessment than on their prior assessment 

Inclusions: 

DRS_cc - Prev_DRS_cc > 0 

Where, 

DRS_cc = DRS score at target assessment 

Prev_DRS_cc = DRS score at prior assessment 

The DRS scale is a measure of a resident’s depressive symptoms, with higher values indicating the resident has more numerous and/or frequent symptoms [ranging from 0 to 14]. Depressive symptoms are based on the following variables:

• Resident Makes Negative Statements (E1a)
• Persistent Anger With Self-Others (E1d)
• Expression of Unrealistic Fears (E1f)
• Repetitive Health Complaints (E1h)
• Repetitive Anxious Complaints/Concerns (E1i)
• Sad/Pained/Worried Facial Expressions (E1l)
• Crying/Tearfulness (E1m)

Where,
Each variable is scored according to the symptom frequency in last 30 days:
0 = Not exhibited in last 30 days 
1 = Exhibited up to 5 days a week 
2 = Exhibited daily or almost daily (6 or 7 days)

Number of long-term care home residents in a fiscal quarter with two valid RAI-MDS 2.0 assessments whose depression symptoms could worsen (i.e., excludes residents who had a maximum DRS score on their previous assessment) 

Inclusions:

Long-term care home residents with two valid resident assessments within consecutive quarters. The assessment selected as the target assessment in the current quarter must: 

• Be the latest assessment in the quarter
• Be carried out more than 92 days after the admission date
• Not be a RAI-MDS 2.0 Admission Full Assessment
• Be from a resident that had an assessment in the previous quarter
• Have 45 to 165 days between the target assessment and assessment in the previous quarter (note: If there are multiple assessments from the previous quarter that meet the time period criteria, the latest assessment is selected as the prior assessment) 

Exclusions:

1. Residents whose depression symptoms could not worsen (i.e., had a maximum DRS score of 14 on prior assessment (Prev_DRS_cc = 14))
2. Residents who were comatose (B1 = 1)

This indicator can be risk adjusted at the individual covariate level and through direct standardization

Individual covariates:

• Age younger than 65 years

Direct standardization:

• Case Mix Index (CMI)*

*The relative resource use compared to the overall average resource use for all Ontario long-term care home residents

Continuing Care Reporting System (CCRS)

Canadian Institute for Health Information (CIHI)

Institution, Province, Region, Time

The results for this indicator include only residents in long-stay beds. Rolling four quarter averages stabilize the rates from quarter-to-quarter variations, especially for smaller facilities, but make it more difficult to detect quarterly changes. Since residents are assessed on a quarterly basis, each resident can contribute to the indicator up to four times. Risk-adjusted values are censored if the denominator is less than 30. General limitations when using RAI-MDS 2.0 data include random error, coding errors and missing values. The indicator calculation is based on the Depression Rating Scale (DRS), and measures an increase in the number and frequency of symptoms of depression. The indicator does not measure a clinical diagnosis of depression. The DRS has low correlation with the Geriatric Depression Scale (GDS) as well as with other instruments.[1,2] The DRS is limited by a larger floor effect than the Geriatric Depression Scale (GDS).[3] In a 2013 study, the DRS was shown to be poor at distinguishing between older adults with and without a medical diagnosis of depression or between older adults who were or were not prescribed antidepressant medications.[4] The COVID-19 pandemic affected many long-term care homes across Ontario, including their ability to complete assessments and/or submit data. Available data may vary by jurisdiction and facility. Results should be interpreted in the context of the COVID-19 pandemic.

Data are based on information from the mandatory Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 assessment. The RAI-MDS 2.0 is a standardized assessment that is completed for each resident upon admission to a long-term care home and quarterly thereafter, by the resident’s care team, by reviewing the resident’s medical records and speaking to the resident and their family. Legacy agency Health Quality Ontario (HQO) used an evidence-informed process and expert panel, composed of Ontario-based long-term care home operators, clinicians and researchers, to produce Ontario benchmarks that represent good resident outcomes and high-quality care. The benchmark for this indicator was set at 13% by an expert panel through a modified Delphi process (2012 & 2015). Alongside public reporting performance indicators, benchmarks are an important tool for supporting long-term care homes and sector stakeholders in tracking progress, setting priorities or targets, and learning from homes that are excelling.

[1] Anderson, RL, Buckwalter, KC, Buchanan, RJ, Maas ML and Imhof, SL. (2003). Validity and reliability of the Minimum Data Set Depression Rating Scale (MDSDRS) for older adults in nursing homes. Age Ageing 32(4):435-8. [2] Hendrix CC, Sakauye KM, Karabatsos G, Daigle D. (2003). The use of the Minimum Data Set to identify depression in the elderly. J Am Med Dir Assoc.4:308–312 [3] Koehler M, Rabinowitz T, Hirdes J, Stones M, Carpenter GI, Fries BE, Morris JN, and Jones RN. (2005). Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatr 5:1. [4] Byma, EA, Given, CW, and Given, BA. (2013). Associations Among Indicators of Depression in Medicaid-Eligible Community-Dwelling Older Adults. The Gerontologist 53 (4): 608-617.

06/10/2025 10:44:00